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A brief addition to the article titled “Wellens syndrome left anterior descending coronary T-wave syndrome”

Welsh, Seana; Morris, Niallb

Colombian Journal of Anesthesiology: October-December 2019 - Volume 47 - Issue 4 - p 260
doi: 10.1097/CJ9.0000000000000135
LETTERS TO THE EDITOR
Open
SDC
Spanish Version

aUniversity of Malta, Msida, Malta

bManchester Royal Infirmary, Manchester Foundation Trust, Manchester, UK.

Correspondence: Manchester Royal Infirmary, Manchester Foundation Trust, Oxford Road, M13 9WL Manchester, UK.E-mail: niallmorris@doctors.org.uk

How to cite this article: Welsh S, Morris N. A brief addition to the article titled “Wellens syndrome left anterior descending coronary T-wave syndrome”. Colombian Journal of Anesthesiology. 2019;00:000–000.

Read the Spanish version of this article at: http://links.lww.com/RCA/A895.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.www.revcolanest.com.co).

Online date: September 19, 2019

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

We warmly applaud the effort taken by Khanna and Bustamante1 in raising awareness about Wellen's syndrome. As the authors report, the syndrome is strongly associated with critical stenosis in the left anterior descending artery and it is frequently overlooked as cardiac biomarkers may not be raised. We feel obliged to respectfully point out 1 error in their otherwise excellent report: the T-wave changes occur predominantly in leads V2 to V3 not V3 to V5.2

While this may seem like a slightly pedantic point, we feel that it is important to clarify as abnormal T-wave changes in 2 leads is a more subtle finding compared to the more widespread precordial T-wave inversion in Fig. 1. While the changes may be more widespread, Wellen's prospective validation reported extension to V1 in just two-thirds of patients, and to V4 in 3 quarters of patients.3

The electrocardiogram pattern is associated with a critically stenosed left anterior descending artery that has spontaneously reperfused and we agree with Khanna et al's management recommendations. The reperfused artery is precariously poised to reocclude, thus the patient should be monitored in a high-dependency area and referred for urgent coronary angiography while medical management is initiated.

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References

1. Khanna S, Bustamante S. Wellens syndrome: left anterior descending coronary T-wave syndrome. Colombian Journal of Anesthesiology 2019; 47:178–179.
2. Rhinehardt J, Brady WJ, Perron AD, et al. Electrocardiographic manifestations of Wellens’ syndrome. Am J Emerg Med 2002; 20:638–643.
3. de Zwann C, Bar FW, Janssen JH, et al. Angiographic and clinical characteristics of patients with unstable angina showing an ECG pattern indicating critical narrowing of the proximal LAD coronary artery. Am Heart J 1989; 117:657–665.

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